To Build a Bridge

Training for Health Professionals and Law Enforcement Officers

Summary Report on the MIPEX Health Strand and Country Reports

EQUI HEALTH Public Report

Border Management and Detention Procedures: Health Perspective




Migration Health: Better Health for All in Europe


Assisting Migrants and Communities


Improving HIV data comparability


HIV-related data on migrant and ethnic minority populations in EU/EEA/EFTA


Mobility of Health Professionals

MHD RO Brussels Publications

The Health Situation at EU Southern Borders - Migrant Health, Occupational Health, and Public Health - BULGARIA 

Full report available here

BG8 Harmanli

Since late 2013 Bulgaria has been experiencing an unprecedented migration influx, mainly caused by the political and economical instability in the Middle East region. Despite the Bulgaria EU membership and its acting as an external eastern EU border, this country remains to a large extend a migration transit zone for migrants continuing their journey towards Western Europe.

Nevertheless, Bulgaria possesses a legal and institutional framework in the field of asylum and migration law and has transposed EU directives into its national legislation consisting of amendments to a number of legal acts such as the the Health Act of 2005, Foreigners Act of 1998 and the Asylum and Refuges Act of 2002. However, limitations within the national legislation persist and further harmonization with international and European law is needed to address administrative barriers and obstacles in the provision of health services to migrants.

The Situational Analysis Report, part of the EQUI HEALTH project – Southern EU Borders sub-action, presents the results of the assessment on Migrant, Occupational and Public Health that took place between February and March 2014 in Bulgaria and further updated until early 2015.

Based on desk research, field visits and interviews with different stakeholders, including law enforcement officers (LEOs), health professionals, public authorities, and non-governmental organizations (NGOs) the assessment examines the policies that either facilitate or hinder migrant’s access to health care in Bulgaria as well as healthcare provision to migrants during all phases of the reception process.

The work was undertaken according to the IOM/WHO/Spanish Presidency of the EU “Global Consultation on Migrant Health” conceptual framework (Madrid 2010).

The Bulgarian legal and institutional framework in the field of migration and asylum law comprises a number of legal acts regulating access to health services for different categories of migrants: asylum seekers, refugee status holders & irregular migrants. However, deficiencies identified in the current legal framework appear to highlight the lack of protocols in place covering the screening for vulnerable groups and the limitations on the free movement of asylum seekers. Consequently, amendments to the current Asylum and Refugees Act legislation are planned in order to further respect international and EU legislation and overcome obstacles identified.

Although the State Agency for Refugees (SAR) administering the open reception centres has received funding from the European Refugee Fund (ERF) to cope with the increasing migrants’ influx, findings from field visits outline existing limitations in the overall conditions in the centres, which determines the overall well-being of migrants. Furthermore, no system exists for the exchange of medical information between health professionals working with SAR in the open receptions centres and the MoI health professionals operating within the detention centres. The Bulgarian emergency health system is overloaded, suffering from insufficient staff and limited provision of health services to the Bulgarian population.

“I am supposed to work part-time but every often I work 8-9 hours a day. At the same time, I haven’t got salary already for three months. I can’t remember already the number of people I own money to.” (HP)


The assessment also highlights the need for technical support for staff working with migrants who experience high level of stress and health related worries. Therefore, training is needed regarding better understanding of the needs of migrants and their difficulties, cultural mediation, common diseases present among migrants, and safety and security at the work place.


“I can’t hide that my officers are constantly worried they might catch a virus and bring it home…We have never had a training. Many of them are not vaccinated. We have requested training for first aid and protection, but nothing happened so far.” (LEO)


Recommendations based on the assessment carried out in Bulgaria are structured in line with the 4 pillars of the IOM/WHO “Global Consultation on Migrant Health” conceptual framework:

1) Policy and legal framework.
2) Partnership, network and multi-country framework.
3) Monitoring migrant health.
4) Migrant-sensitive health system.

In this context, there is urgent need for developing common and resolute EU operational responses, and expand and promote EU legislation to facilitate safe entry into the EU and adequate provision of health services to migrants.

On the other hand Bulgaria’s reception system should ensure respect for human rights, integrate health policy in reception centres and promote a network for the exchange of information between all structures and services working with migrants.

Analysis of the findings also highlights the need to develop a comprehensive health assessment and health data collection. Furthermore, there should be an integration of the health policy in reception centres in order to ensure compatibility with the national health system, including the overcoming of communication barriers related to information on health-care entitlements to migrants.

The assessment also highlights that efforts should be placed on reinforcing health and social support systems, including cultural mediation and training for staff involved on migration related issues, both health and law enforcement professionals. Conclusions from this report suggest an improvement on living conditions for migrants in reception centres, including overall infrastructure maintenance and integration activities. 

BG Harmanli girl 2

The Assessment report was draft under the IOM MHD Brussels Regional Office guidance by Milen Petrov from IOM MHD Sofia, and edited and revised by Maria Samuilova. DJ Krastev copy-edited, proofread, and assisted the general editing.

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